CHARACTERIZING GENERATIONAL CAREGIVING USING DATA FROM THE BRFSS

Abstract As the proportion of family and friends in the U.S. providing informal care increases, it is important to understand how this may impact certain demographic groups. Millennials and older adults are two generational segments of caregivers of interest given the complexities associated with these groups. Millennials can be sandwiched between a growing older population of parents or grandparents while also raising young children, often providing care for both. Similarly, older adults frequently balance caring for spouses, themselves, and grandchildren. We characterized these two groups of caregivers using 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) data from the Caregiver Optional Module administered in 44 states, D.C., and Puerto Rico. Among 246,223 Module respondents, 21.3% reported providing care for a family member or friend. Among caregivers, 12.4% were identified as Millennials (aged 18-38 years), and 19.7% were older adults (aged≥65 years). About one-in-three Millennial caregivers reported providing care to a parent and half to another relative, such as a child or grandparent. While less than 4% of Millennial caregivers reported providing care for a spouse, nearly one-in-five older adult caregivers did. Although their care recipients may differ, both groups reported high intensity of care, with 30% of caregivers in each group providing 20 hours of care or more weekly. Caregiving among older adults can be further complicated by their own health difficulties, with over half of older adult caregivers reporting having two or more chronic conditions and one-third reporting a disability. BRFSS data may inform planning efforts pertaining to these caregiving groups.

Communication quality between clinical care teams and families impacts important outcomes like satisfaction, depression, and anxiety. Assessment tools must be efficient and reliable to be useful in the clinical environment. We report the development of 5 and 10-item versions of the validated 30-item Family Inpatient Communication Survey (FICS). Data were from 364 surrogate decision makers (SDMs) for incapacitated older adults in the ICU. Most SDMs were adult children (66.8%). SDMs were 70.9% female, 68.9% white, with a mean age of 58.3. Exploratory factor analysis revealed high internal reliability for the single-factor FICS5 (α= .88) and two-factor FICS10 (α= .93). The FICS10 reliably measures two subscales: information (α= .91) and emotional support (α=.81). Good discriminant and predictive validity were demonstrated when comparing total scores to outcomes at 6-8 weeks after hospital discharge, including anxiety (correlation coefficient (ρ)= -.13; p=.0234 ), depression (ρ =-.15; p=.0076), decision regret (ρ =--.15; p=.0066), and satisfaction (ρ =-..48; p<.0001 Research,Regenstrief Institute,Inc.,Indianapolis,Indiana,United States,3. Indiana University,Indianapolis,Indiana,United States,4. Regenstrief Institute,Inc.,North Vernon,Indiana,United States Brief, reliable assessment tools are highly valued in both research and clinical settings. The single-item Distress Thermometer (DT) asks participants to rank their overall level of distress from zero to ten. Similar measures of distress perform well in oncology populations, but the validity of the DT has not been well tested with other populations. To determine its validity and reliability, we analyzed data from family surrogates (n=188) of critically ill ICU patients. Surrogates were asked to rate their distress during the first four days of the patient's ICU stay and 6-8 weeks after discharge (n=127). Data were analyzed using Spearman non-parametric correlation due to the distributions of the data. DT scores at both baseline and follow-up were significantly correlated with anxiety (GAD-7: correlation coefficient (ρ)=.527, p<.0001; ρ=.543, p<.0001, respectively), depression (PHQ-9: ρ=.480, p<.0001; ρ=.399, p=.0002), distress (Kessler-6: ρ=.477, p<.0001; ρ=.528, p<.0001), and negative religious coping (ρ=.149, p=.0426; ρ=.238, p=.0074). Results also indicated that spiritual well-being at baseline and follow-up (FACIT: ρ=-.391, p<.0001, ρ=-.443, p<.0001) and positive religious coping at baseline (RCOPE: ρ=-.164, p=.0253) have an inverse relationship with overall distress. At baseline, surrogates with better positive religious coping and/or more involvement in organizational religious activity (ρ=-.189, p=.0106) were more likely to report lower distress. The DT could be an efficient, single item predictor of outcomes that impact patient and family care. Future research could confirm its validity as a measure of distress, in a variety of clinical populations and environments that could inform clinical care for patients and families.
University of Utah, Salt Lake City, Utah, United States, 3.

Alzheimer's Association, Chicago, Illinois, United States
As the proportion of family and friends in the U.S. providing informal care increases, it is important to understand how this may impact certain demographic groups. Millennials and older adults are two generational segments of caregivers of interest given the complexities associated with these groups. Millennials can be sandwiched between a growing older population of parents or grandparents while also raising young children, often providing care for both. Similarly, older adults frequently balance caring for spouses, themselves, and grandchildren. We characterized these two groups of caregivers using 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) data from the Caregiver Optional Module administered in 44 states, D.C., and Puerto Rico. Among 246,223 Module respondents, 21.3% reported providing care for a family member or friend. Among caregivers, 12.4% were identified as Millennials (aged 18-38 years), and 19.7% were older adults (aged≥65 years). About one-in-three Millennial caregivers reported providing care to a parent and half to another relative, such as a child or grandparent. While less than 4% of Millennial caregivers reported providing care for a spouse, nearly one-in-five older adult caregivers did. Although their care recipients may differ, both groups reported high intensity of care, with 30% of caregivers in each group providing 20 hours of care or more weekly. Caregiving among older adults can be further complicated by their own health difficulties, with over half of older adult caregivers reporting having two or more chronic conditions and one-third reporting a disability. BRFSS data may inform planning efforts pertaining to these caregiving groups.

PERCEIVED NEEDS, FELT CONCERNS, AND QUALITY OF LIFE OF OLDER ADULTS IN MISSISSIPPI: AN INTERGENERATIONAL APPROACH
Muhammad Riaz 1 , Laura Downey 2 , Carolyn Adams-Price 3 , Donna Peterson 2 , Lori Staton 2 , and Alisha Hardman 2 , 1. Mississippi State University, Starkville,Mississippi,United States,2. Mississippi State University,Mississippi State,Mississippi,United States,3. Mississippi State University,STARKVILLE,Mississippi,United States The purpose of the study was to identify felt needs and concerns of older adults living in their own homes in Mississippi using intergenerational perspectives. This mixedmethods study used snowball sampling to collect data through semi-structured interviews and structured questionnaires that asked about the quality of life and current and future problems among aging adults. Three generations of Mississippians participated in the study, including grandparents (N = 22), adult children (N = 23), and grandchildren (N = 19). Quantitative data were analyzed using SPSS, while qualitative data were managed with MaxQDA. Respondents identified concerns with physical health, difficulty living independently, and mental health problems affecting life satisfaction and quality of life. Incongruently with the intergenerational stake hypothesis, adult children were more invested in their children than their parents. Older adults who live closer to significant others and family were more resilient despite having physical and mental issues. Physical issues related to mobility, access to daily need services, and help with basic tasks like food preparation and mowing lawns, and issues related to mental health seemed less pronounced. Consistent with other research studies, older adults showed a positive sense of self. Similarly, parents showed resilience without being intrusive and overbearing while considering themselves as support for their children. Results could inform the development of programs or initiatives for grandparents, adult children, grandchildren, and others involved in caregiving activities and planning for older adults in Mississippi.

ASSOCIATION OF CARDIOVASCULAR DISEASE WITH RACE/ETHNICITY IN FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA
Dawon Baik 1 , Bryan McNair 2 , and Sophia Centi 3 , 1. University of Colorado,Aurora,Colorado,United States,2. Colorado School of Public Health,University of Colorado Anschutz Medical Campus,Aurora,Colorado,United States,3. CU Anschutz Medical Campus College of Nursing,Aurora,Colorado,United States Family caregivers of persons with dementia (dementia FCGs) experience high caregiving burden, and caregivingrelated stressors have been linked to cardiovascular disease (CVD). Racially and ethnically diverse FCGs face additional challenges in managing their own health; however, racial/ ethnic disparities in caregiving-associated cardiovascular health are understudied and poorly understood. To fill the gap, we evaluated racial/ethnic differences in CVD risk and CVD conditions among dementia FCGs in the U.S. Using 2015-2020 Behavioral Risk Factor Surveillance System data (N = 6,132), we compared CVD risk and CVD conditions in racial/ethnic dementia FCG minorities to non-Hispanic White dementia FCGs. Logistic regression models were used to estimate unadjusted (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI) for association of race/ ethnicity with CVD risk and CVD conditions, adjusting for potential confounders. Compared to non-Hispanic White FCGs, non-Hispanic Black FCGs (AOR 0.33, 95% CI 0.2-0.53) and non-Hispanic Asian FCGs (AOR 0.16, 95% CI 0.05-0.51) were less likely to have depressive symptoms. Hispanic FCGs (OR 0.69, 95% CI 0.5-0.95), non-Hispanic Black FCGs (AOR 0.6, 95% CI 0.41-0.86), and non-Hispanic Asian FCGs (AOR 0.51, 95% CI 0.28-0.94) were less likely to smoke. Non-Hispanic Black FCGs were less likely to exercise (OR 0.69, 95% CI 0.52-0.91) and more likely to be obese (AOR 1.64, 95% CI 1.14-2.36). The findings confirm racial/ ethnic disparities in psychological, behavioral, and metabolic risk factors for CVD among dementia FCGs. Future studies should investigate how dementia FCGs' caregiving-related conditions affect CVD and how racial/ethnic considerations can inform culturally appropriate prevention-care strategies. In 2020, the Los Angeles County Department of Public Health launched Healthy Brain LA (HBLA). HBLA is a Innovation in Aging, 2022, Vol. 6, No. S1